Piano Assessment Form
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Customer Name
*
Phone
*
Email
Adress
City
Service Request No:
Date
*
Piano Type
Concert Piano
Grand Piano
Upright Piano
Digital Piano
Other
Piano Technician
Piano Brand & Model
Serial
Color
Condition
Piano Case/Cabinet
Color Faded
Has Dents & Scratches
Paint Crack
Rusty Pedals & Wheels
Solution
Partial Repaint
Full Repaint
Polish Only
Other
Piano Action Mechanism
Regulation Required
Repair Required
Voicing Required
Parts Required
Tuning Required
Minor Repair
Other
Pedal Trap Work
Rusted Pedals
Broken Pedals
Other
Solutions
Adjustment Required
Repair Required
Other
Strings & Tuning Pins
Bass Strings
Broken Strings
Tuning Pins Rusted
Pins Old
Pin Block Damaged
Strings Rusted
Other
Solutions
String Cleaning
Change Strings
Change Tuning Pins
Change Bass Strings
Other Solutions
Sound Board
Dirty
Has Cracks
Fully Damaged
Other
Solutions
Cleaning Only
Repair Cracks
Full Replacement
Other Solutions
Piano Tuning
Standard Tuning
Pitch Raise Tuning
Extended Pitch Raise Tuning
Other Comments
Customer Digital Signature
Technician Digital Signature
Submit
